Billing a Snore Guard in the Dental Office

If you regularly bill D5999 (Snore Guard) to dental insurance and get denials, you could be missing an opportunity for treatment acceptance.

You can bill the medical insurance for the snore guard, even if you are not in network. In fact, most medical networks don’t have an adequate amount of dental providers in their network and have to pay your practice as an in network provider if you ask them about the patient’s gap coverage.

There are several differences that must be addressed for the medical claim to be approved.

1. Often times a medical plan requires pre-authorization for the service. In dental we regularly obtain pre-determinations of benefits to see how a plan will likely pay once a claim is submitted, but this is optional. In medical billing, services requiring a pre-authorization are mandatory and the claim will be denied without one.

2. A medical claim must be printed on a red CMS 1500 (or current medical form) and can not be printed out as black and white.

3. A diagnosis code is necessary. This code for obstructive sleep apnea is G47.33

4. An HCPCS code is necessary instead of the ADA code of D5999. Currently that code is E0486. The official name for this code is custom-fitted obstructive sleep apnea appliance.

5. In medical, this service is paid under durable medical equipment (DME). Because DME can come as new or used a modifier of NU must be entered.

6. Although the casting, fitting and delivery happened in the office, the place of service will actually be home as this is the location the patient will use the device the majority of the time.

After all of this is completed, send out your claim. Make sure the pre-authorization number is included on the claim and then we wait. If your claim comes back denied “no out of network benefits” or processes as out of network, make sure to call and remind them of the gap coverage.